OCN Level 2 Dementia Awareness Application form

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Please complete the form fully
We will invoice NAPA Members at a rate of £400.00 per learner.
We will invoice Non NAPA Members at a rate of £1,000 per learner.
Please contact : info@napa-activities.co.uk with any questions
Many thanks
The NAPA Team

Name of care setting: *

Organisation: *

NAPA Member * *

Yes

Not sure * We will check and let you know

What is your membership number?

Address, including postcode: *

Telephone number: *

Email address for any queries *

Invoice address, if different to above:

Email address for invoice: *

Purchase Order Number (if applicable :)

Managers email address *

Full Name of Learner 1 *

Learner 1 Email address *

I confirm that the student named above has good standard English( written , spoken) and English comprehension, and understand the registration is only valid for 2 years, and if the course is not completed within the timescale the student will be withdrawn, without refund. I confirm that the above details are correct and I understand that once the student/s has/have been registered there will no refunds given. *

Yes

Name of person completing form *

Date *

YYYY

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